Individual
CRYSTAL RICH PONTIVEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5401 FOUNTAIN AVE, LOS ANGELES, CA 90029-1006
(323) 465-2106
Mailing address
1122 E ELK AVE APT 106, GLENDALE, CA 91205-4604
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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